Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 004950 | NY |
NPI | 1003055039 |
---|---|
Provider Name | Effie Tatakis |
First Address | Brooklyn, NY 11210-2549 |
Second Address | Brooklyn, NY 11234-4930 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2009 |
Last Update Date | 10/10/2018 |